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@n_skotak @NAUPT582 Right, but what about those pts that already have OA? Not only do we have to educate them about the common misunderstanding that exercise will make it worse, but we also have to deal with the fact that they're in pain. Thoughts?

@LewisTam5 #PT582 #LT 2 Questions come to mind. 1) How can PTs prevent people from relying too much on the joint before they develop OA? 2) How do we know, when prescribing exercises, that we are targeting the muscles rather than simply putting more strain on the joint?

#PT582 #RP This studies said that weakness of the knee extensors is a risk factor for developing OA oarsijournal.com/article/S1063-…. In fact, weakness of the muscles surrounding the joints will cause people to rely more on the joint, like hyperextension causing buckling of the knee.

@KSandifer_SPT #PT582 #KS Yeah, I agree. So that makes me wonder, correcting body mechanics and strengthening can be great ways to slow the progression of OA, but is there any way to catch these risk factors before OA develops in the first place?

#PT582 #RP Being overweight, joint surface incongruency or malformation, joint injury or genetics can all play a role in the development of OA. I do believe repetitive stresses if they are done with poor body mechanics or decreased strength can lead to OA bit.ly/2wP9XFX

@nutmeg91 #PT582 #MF Great point. So then, how do we determine dosage? How much is too much and how little is too little?

#PT582 #RP Riley, take a look at this article, paired will the affect of muscles offsetting ground reaction forces, the joint loading actually encourages bone density increases which can offset OA. I think as we discussed in class it comes down to dosage. jamanetwork.com/journals/jama/…

@Reannon26 #PT582 Reannon, thanks for the input. Regarding educating pts about this, how do you think we should go about doing so? If somebody, even a PT, told me that putting more strain on arthritic joints was helpful, I would probably not have believed them.

#PT582 #RP Some factors that increase risk of OA are having a previous injury, obesity, gender, and genetics. I think it is important for us to educate patients that activity doesn't cause OA & strengthening surrounding muscles helps to stabilize the joint mayocl.in/2L6EaLy

@dannyspt13 #PT582 #DS Danny, great find. What do you think is the physiological mechanism by which ACL tears contribute to OA?

#PT582 #RP bit.ly/2uLvDmv This retrospective cross-sectional study found that previous ACL or meniscus injury lead to the development of knee OA about 10 years post injury (on average).

@kalechip00 #PT582 #KC Prior injuries, great point. Do you think this is a from the knee injury itself (infammation?), resultant instability, or altered biomechanics following the injury? According to this study at least, there are some correlations with mechanics. bit.ly/2mwpNBq

Unfortunately knee injuries do increase the risk of getting OA so when working with patients make sure to increase that strength and endurance of those muscles surrounding the knee! #RP #pt582 bit.ly/2JCvQxq

@runinthemtns #PT582 #KT Right! So I wonder, how would that affect your treatment? Would you address obesity in an elderly pt who has been obese his/her whole life? If so, keeping in mind that being obese, and thus having more inflammatory markers and excess strain on joints, how would you?

#PT582 #RP Most research shows evidence that some of the most important risk factors for developing osteoarthritis are obesity and unfortunately for women, gender. cdc.gov/arthritis/basi…

@mpwheeler47 #PT582 #MW Great (and not horrible) question. I do think bad mechanics can contribute, but I think altering form could be done (to an extent) by increasing strength in certain muscles and mobility in certain joints rather than by training/telling pts to do it differently.

#PT582 #RP Risk of OA that our pts can regulate are obesity, infection, joint injuries, occupation & smoking. Do you think repetitive poor running mechanics could indirectly lead to OA via joint injury & if so would you try to alter their form knowing how hard it is to do so?

@amkaiserSPT #PT582 #AK Yeah, definitely makes sense. There's still a question though, it seems to me, about how much is too much. What if the forces people are putting through their knees are excessive or they do not have enough stability to handle them? What if people have OA already?

#PT582 #RP knowing that compressive forces stimulate hyaline cartilage and type II collagen adaptations, don't you think that some sort of loading must be preventative for OA of these WBing joints? Your thoughts?

@Christo54275309 Interesting. This is definitely counter intuitive, and that is part of why information along these lines struck me in class. It makes sense that high intensity exercises would be ideal for prevention, but I am still surprised that they are effective for treatment. Great find.

This article compares high-intensity vs. low-intensity exercise in the treatment of OA and concluded that those who partcipated in high-intensity exercise saw greater overall improvements in pain reduction and function. researchgate.net/profile/Christ… #PT582 #RP

@TommyLittlePT #PT582 #TL Thanks for the reply, and great point about research and popular belief. It makes a lot of sense that immobilization is a risk factor for OA, but I was not aware. So thanks for the info!

#PT582 #RP Great question Riley! Research and popular belief are often in opposition, and according to this systematic review, exercise not only builds up tissue surrounding the joint (muscle, soft tissue, etc.) but also the articular cartilage (due to it’s adaptive...

@NAUPT582 #PT582 Kailey, I assume plyos are beneficial for joint arthroplasty due to their effects on nerves. For safety, intensity and difficulty can probably be modified appropriately? Hard to find much, but pg 150 states they work well for TKAs. bit.ly/2NOmlyD

@NAUPT582 #PT582 Austin, cool question! According to this article, it improves hand function, but not spasticity in stroke patients. bit.ly/2uixkIG

@NAUPT582 #PT582 Nathan, this study found instability in the segment above the fusion in 45% of pts who underwent lumbar fusion surgery. bit.ly/2tREx29 It makes sense then that, as this study found, there would be adjacent segment degeneration: bit.ly/2NkOFbE

@NAUPT582 #PT582 Kaitlyn, I am really interested in nutrition and I would love to be able to make it part of what I can do to help people. Legal issues aside, I think to be qualified we would have to research/educate ourselves because we do not get enough information in school.

@NAUPT582 #PT582 Kaele, here is a design for an ongoing study looking at this issue (no results yet): bit.ly/2NmkKA5 And this presentation recommends several balance exercises including stability training on a physioball and "toe box jumps" bit.ly/2KNUArz

@NAUPT582 #PT582 Jake, I bet that the best training program would be the one most tailored toward motivating that specific patient since pts with Parkinson's often suffer from a lack motivation. bit.ly/2IA8BUc Did the pt used to box, dance, swim, run, do gymnastics?

@NAUPT582 #PT582 Megan, one idea is group therapy, which increases adherence bit.ly/2tDMubb Since aquatic therapy is generally group therapy, it seems to be effective for groups that are often unmotivated like pts with fibromyalgia: bit.ly/2tFkHqy

@NAUPT582 #PT582 Stephanie, as with anything, it depends. We can't say plyometrics are safe for them since many have osteoporosis, but many are healthy. This study shows efficacy: bit.ly/2yxgV7P and the APTA mentions plyometrics for geriatrics: bit.ly/2Md8RL9